Treasury May Recover Billions from Health Care Fraud Cases
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MCALLEN – The Office of Inspector General is reporting their work this year could be returning billions to the treasury.
Some of that comes from what they expect to recover for criminal actions like health care fraud.
There are six cases the OIG helped investigate in the Rio Grande Valley. Millions of dollars were billed by people attempting to defraud the government.
People were charged, indicted or convicted of filing false and fraudulent claims to Medicaid and Medicare this year.
It's the job of the Medicaid fraud control unit to catch it. OlG Spokesperson Donald White says their attention is focused on McAllen and Houston.
"What we call outliers, that is billing that is off the chart or numbers that health care organizations that far exceed the average per population. Why that's true in McAllen, we do not know,” said White.
In 2017, they worked on six cases in the Valley. In one case, Medicaid paid out $3.1 million to Compassionate Medical Supply. It's a durable medical equipment company in Edinburg.
In another case, a lab tech and an account representative for a toxicology testing company were charged with a scheme that billed Medicare over $836,000.
The federal government claims they falsified patient and doctor signatures to send urine specimens to the testing clinic.
One of the most penalized cases was one where Medicaid paid out nearly $2 million.
The owner of the McAllen company, Hacienda DME, and four co-conspirators were all sentenced and ordered to pay.
The owner received 12 years in federal prison. The other four were sentenced to serve from six months of home confinement to 21 months in prison.
Altogether, the five were ordered to pay $6 million in restitution for the loss to the Texas Medicaid program. The investigation and prosecution efforts yielded $4.4 billion nationwide.
White said, "That is money that gets returned to the treasury. It’s money that hard-working taxpayers had to pay in and now can go for needed Medicare and Medicaid services."
Three of the six cases involved kickbacks received for Medicare patient referrals.
One case involved a man using a stolen identity to pose as a nurse. He was sent to prison for two years.
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